Senior Registration Form 2026/27

Date of Birth - using following format - e.g.07/03/21

Name of Emergency Contact 1

Emergency Contact 1 Mobile Number

Relationship to Club Member

Name of Emergency Contact 2

Emergency Contact 2 Mobile Number

Relationship to Club Member

Medical Information - ALL club members are required to provide medical information as accurately as possible. You must advise the club immediately of any changes to the information you provide.

Do you have any long term illnesses or injuries we should be aware of?

Yes

If you have answered yes to above please provide details below

Please provide details of any regular medication we should be aware of:

As far as you are aware, are you allergic to any medication?

Yes

If you have answered yes to above please provide details below

Membership Type

Full Time Student/Unemployed

Senior Member

Back to Hockey Group

Please tick any Voluntary Roles you are interested in

Add any additional volunteering details below

I have read and agree to the Terms & Conditions set out in the Member Declaration on the Club Website. https://www.rhonddaladieshockeyclub.com/member-declaration

Yes

I have read and agree to the Terms & Conditions set out in the Privacy Policy on the Club Website. https://www.rhonddaladieshockeyclub.com/policiesprocedures

Yes

Senior Registration Form 2026/27

Date of Birth - using following format - e.g.07/03/21

Name of Emergency Contact 1

Emergency Contact 1 Mobile Number

Relationship to Club Member

Name of Emergency Contact 2

Emergency Contact 2 Mobile Number

Relationship to Club Member

Medical Information - ALL club members are required to provide medical information as accurately as possible. You must advise the club immediately of any changes to the information you provide.

Do you have any long term illnesses or injuries we should be aware of?

Yes

If you have answered yes to above please provide details below

Please provide details of any regular medication we should be aware of:

As far as you are aware, are you allergic to any medication?

Yes

If you have answered yes to above please provide details below

Membership Type

Full Time Student/Unemployed

Senior Member

Back to Hockey Group

Please tick any Voluntary Roles you are interested in

Add any additional volunteering details below

I have read and agree to the Terms & Conditions set out in the Member Declaration on the Club Website. https://www.rhonddaladieshockeyclub.com/member-declaration

Yes

I have read and agree to the Terms & Conditions set out in the Privacy Policy on the Club Website. https://www.rhonddaladieshockeyclub.com/policiesprocedures

Yes